Individual provider Active NPI

Brooke Brannon Polyakov, D.D.S.

  • Dentist
  • Santa Rosa, CA
National Provider Identifier
1821719659
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
107997 Issued in CA
Practice address
140 Stony Point Rd Ste a
Santa Rosa, CA 95401-4121
Phone
(707) 408-7838
NPI assigned
Sep 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 19928 CA
Dentist 122300000X 107997 CA Primary

Addresses

Primary practice location

140 Stony Point Rd Ste a
Santa Rosa, CA 95401-4121

Mailing address

140 Stony Point Rd Ste a
Santa Rosa, CA 95401-4121
Phone (213) 407-5945

Other practice location 1

2664 Berryessa Rd Ste 108A
San Jose, CA 95132-2906
Phone (408) 217-1597

Other practice location 2

1851 Sutter St Ste B
Concord, CA 94520-2559
Phone (925) 515-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
107997CAMDDentist
19928CAMDSpeech-Language Pathologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1821719659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 STONY POINT RD STE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014121",
            "telephone_number": "213-407-5945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 STONY POINT RD STE A",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014121",
            "telephone_number": "707-408-7838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2664 Berryessa Rd Ste 108A",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951322906",
            "country_code": "US",
            "telephone_number": "408-217-1597",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1851 Sutter St Ste B",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "CA",
            "postal_code": "945202559",
            "country_code": "US",
            "telephone_number": "925-515-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLYAKOV",
        "first_name": "BROOKE",
        "middle_name": "BRANNON",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-09",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "19928",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "107997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.